Monday, November 13, 2017

Saturday, November 11, 2017

Diary of a Third-Year Vet Student: The Journey

It's been a busy term with exams and surgeries nearly every week. It feels so much like first year--we are buried in mountains of information, don't have much time to process it before being tested on it, and no time to reflect on it afterwards because we are looking up at the next mountain of lecture notes that we need to go through. Even so, I've had a post queued up for over a week, but after thinking it over, I decided to ditch it and go in another direction. 

Vet school is incredibly stressful. Part of it is learning minutiae of the physiology, anatomy, diseases, parasites, and reproductive habits of 8 to 10 species (at a minimum), and how to alter or repair those things with drugs, nutrition, surgery, husbandry. Part of it becomes so much more real in the junior year when we do the dog and cat neuter/spays in our surgery lab. Cutting into a living, breathing animal is amazing and terrifying by turns. 

This fall term has not gone well for many of us. People who make it this far in vet school are typically not the kinds of people who react calmly when things don't go well. In other words, when someone who is used to performing at a high level in all things encounters failure, it's not pretty. Oh, of course, let's be rational: nobody can be good at everything. But that is not good enough. We vet students reject that almost to a person. The result is lots of stress, lots of tears. I don't want to give the impression that every day at at school is filled with day-care toddler meltdowns. Not at all. The stress and tears fill the interstitial spaces. 

Sadly, veterinarians are more likely than other adults in the general population, even adults in other medical fields, to experience depression and have suicidal thoughts

There is increased awareness of this situation among vet students. It helps that professional organizations like AVMA are publishing results of studies like the one linked above. However, there is still reluctance to talk openly about our stress and anxiety. It is as if, by saying, I did not do this thing well, we are saying, I failed at this thing. I hope you can see that there is a universe of difference between those ideas. The problem is that vet students (and ultimately, veterinarians) are a tiny subset of the population that were selected by a vet school precisely for a particular combination of traits. I think that one of those traits is that we can't admit failure. When you combine that with the fact that death is a daily component of a veterinarian's job, it is an explosive and toxic situation. 

 I think that our class is getting better at talking to each other. We all need a bit of prodding to get started. But give one of my classmates a poke, and suddenly she is telling you about fears and anxieties that are exactly yours as well. And you realize, you are not alone in this. We are getting better about looking after each other, even if we don't talk about things openly and easily. Sometimes a hug is needed. Sometimes we need to check in on each other a little more directly. Sometimes we need to give affirmation: I see you, I value you as a person.

None of us had illusions that the journey to becoming a veterinarian would be straightforward or easy. And I don't think we are complaining that it's too hard. Learning how to manage the stress properly is now part of our routine just as much as learning about the medicine. 

Tuesday, October 24, 2017

Diary of a Third-Year Vet Student: Kitty!

I completed my first cat spay yesterday. It was a long, grueling afternoon. The surgery is difficult--the tissues are tiny and delicate (our cat was at most 8 months old), and it was the first time most of us had ever opened up an abdomen, so the cutting and the closure procedures were much more complicated than what is required for a dog neuter. But unlike my first surgery, I didn't stumble out of the building afterwords wondering what the heck just happened. I felt like I owned this surgery. What made it so much more powerful was going in this morning at 6am to check on kitty and seeing that her incision was not red or bruised or oozing, watching her gobble the jar of chicken baby food and a good third of a can of the wet food that Beast eats, both of which I brought in from home, and having her purr and knead her paws so much that I could hardly conduct her physical exam. Even cleaning up urine-soaked pellets from her litter box made me happy--it meant that I didn't damage her delicate ureters which are located quite close to her uterus. Or what's left of her uterus. I took most of that out along with her ovaries.  


It wasn't perfect. We are still learning, and mistakes are inevitable. The key is to catch them, get help, and correct them right away. 

The surgeries take far longer than they would in a clinical setting. This means that your teammate who has anesthesiology duties for that surgery has a really important job: keeping the patient alive. But as hectic as this surgery was, my teammate managed to snap some pictures of me and my assistant, and I'm really grateful to her for that. 


I've written quite a few more paragraphs for this post then deleted them. What we vet students are doing is not a secret, but as we advance in the program, I'm finding few laypeople are as into the details as we are. I'm finding that the details can be distressing to some people. With the current anti-science and anti-fact climate in our country, descriptions of how doctors and veterinarians learn and perform our trade can be twisted and turned around to suggest that we are being immoral or cruel or used to support arguments that we are not to be trusted. I don't want the blog to become a source for that kind of misinformation. So I will leave the details of the surgery for another day.

Friday, October 13, 2017

Not Today, Satan. Not Tomorrow Either.


You might have noticed that the volume of public/media conversations about sexual predators has been increasing in the past couple of weeks. I have some comments to make about this.

As a woman working in a conservative, male-dominated field for nearly two decades, I experienced sexual harassment in all of its overt as well as subtle forms. I fended off most harassers with the direct approach: touch me again or speak to me like that again and I’ll hand your balls back to you on a platter. I had no problems speaking up and went to supervisors and mentors on several occasions when the direct approach was not effective. I was never dismissed or ignored. I had no idea how lucky I was.

I never encountered the more destructive and insidious “Weinstein” style of harassment until last year. Not surprisingly, it was within an academic setting. The academy is as notorious as the entertainment industry for its poor treatment of women. I could single out STEM fields but there are predators in every discipline, not just the sciences.

I first encountered this particular predator via the “whisper network.” Third- and fourth-year vet students would quietly tell the freshman and sophomore students to keep an eye on this guy. He would stand too close. He would say inappropriate things. He would try to touch you. It wasn’t possible to avoid him entirely since he taught a required course for second-year vet students. He’d been doing these things, and much worse, for decades, but few students were willing to jeopardize their grades and degrees by speaking up. While they certainly knew about this, deans and university administrators can’t act on rumors. And although I think one of the charms of the academy is that tenure can shelter eccentricity, the very dark flip side is that tenure can protect predators.  

I was on high alert whenever this predator was in my vicinity, but I was not expecting any interaction with him. I was not his type at all. He is taller than average and I watched him repeatedly use his height to physically dominate smaller female students. That’s what his kind of predation is all about: exploitation of power differentials and domination.

However, to my surprise, he did actually say something to me that was so inappropriate, so shocking, that I went straight to the dean’s office and reported it. I don't view myself as a hero or a warrior. I reported it because I was mad as hell that this kind of gross behavior occurred in my vicinity. I was mad as hell that this fucker had been getting away with this for years. I was mad as hell to think that he could target other classmates, some of whom I’m rather fond of.

The dean did not ignore me or dismiss me. Phone calls were made. Additional meetings were held with other university administrators. I felt like I had been listened to.

As it turned out, I was not only listened to but things begin to happen. At the end of the summer, I was asked to testify before a faculty panel convened by the university president to evaluate the many accusations that had been accumulating around this predator for years and to determine whether he should have his tenure revoked. I was a witness for the outside counsel hired by the university to represent their interests in the matter. Not everyone involved was willing to appear in person, because there was questioning and cross-examination. I totally understand that. First you are afraid that, if you speak up, you will not get approved for a grant, will not pass a class, will not be able to advance in your academic career. Then you are told, we want you to face this fucker and his rude lawyer in a small, stuffy room crammed with people you don’t know and tell your story. That is just too much for most people. However, I am not so easily intimidated. This is not always a good character trait to have, believe me. 

The final outcome is still pending. But I know that I did the right thing by speaking up. The predator has been removed from all duties involving teaching and supervision of students. It’s just a matter of time.

Monday, October 09, 2017

Archie On Fire--UPDATED

No, Archie is not literally on fire. But he has been burning it up in the agility ring lately. We had a bit of a break with no trials and no classes from late August to early September, and I think that was good for both of us, but we are back in the swing of things. Sadly, my surgery schedule this term prevented me from continuing with his Monday night class. He's been going to that class since he was 8 or 9 months old. I had to switch to a new night, new time, and new instructor. There are risks and benefits to moving to new classes and new instructors. Group dynamics are important, especially in small classes. And his original agility instructor definitely figured out the best way to handle me. I hope that I can communicate with the new one as well. I won't find out for another couple of weeks. But we continue with our Thursday night class which provides us with plenty of international handling challenges.

Vet school is becoming rather intense. I continue to go to trials but I only go one day, usually Saturday (most trials in this part of the world are three days long). One day seems to suit Archie just fine. He earned his Excellent Jumpers title this past Saturday, and can now start accumulating precious MACH points. He turned 2 years old on Sept 21, so that's a nice accomplishment for a young dog. 

UPDATE: I left the trial before placements were posted and wrote this before I received the confirmation email with the results. Not only did Archie earn that Q and his Excellent Jumpers title, he placed first in the 16" class. I kind of regret not sticking around and picking up that spiffy blue first-place ribbon. Go, Archie, go!

He has yet to earn an Excellent Standard leg but that's not for lack of effort on either my part or his. While he can struggle with contacts at trials because he is so damned high, an entirely unexpected problem has cropped up: the table. He doesn't want to get on the table at a trial. He performs the table perfectly, at speed, in class and at home. At a trial, meh, he says, I'd rather not. 

It is very possible that he just doesn't want to stop. That table represents a weird point of inactivity in a Standard run--the dogs have to jump on it and remain on it for the judge's count of five seconds (they can sit, down, or stand). One reason Archie has been doing so well in Jumpers is that he gets to run fast, run furious. He likes that! He was the fifth-fastest dog in his qualifying run in Jumpers on Saturday. That's quite competitive for a dog as young and green as he is. He still turns a bit wide and drifts here and there, and I know his speed will only improve as my handling and his path tighten up. He does have stopped contacts but I release him fairly quickly from those. The table is another challenge entirely for a dog like Archie. 

Archie doing a very nice teeter. Photo by Joe Camp, July 2017.

It's also possible that I am doing something different at trials when I approach the table. So I plan to ask someone to film us at the next trial. I haven't had a video of him in a while anyway.  

For the trial this past weekend, the hosting club decided to rent out some space in the large arena where the agility trial was held for a barn hunt test. Barn hunt tests and titles are managed by a separate organization, not AKC. Bales of hay are piled artfully in small, fenced-off bays, with a rat in a cage sequestered somewhere within. Dogs, mostly terrier types, have to find the rat within a specified period of time. It's kind of like earthdog but above ground. When I found out that the barn hunt ring was immediately adjacent to one of the agility rings, I was Not Happy. I began a mental draft of the stern email that I planned to send to the hosting club. I walked the boundary fencing line between the rings, marking all the places that a determined fox terrier could leave the agility ring and get into trouble on the other side. The other side where there were unleashed dogs and rats in cages all day long. My god, the potential for chaos was nearly infinite.

I should have had more faith in my dog. I have built an absolute crazed obsession for agility into Archie. He chooses agility over other dogs, other people, other distractions. He never even eye-flicked to the barn hunt side of things. In the ring, he was all about the game. 

I am incredibly proud of my fox terrier, even if he thinks the table at the trials is made of lava.

Sunday, October 08, 2017

Diary of a Third-Year Vet Student: Touching Real Animals

After two years of a lot of foundational material and long discussions of diseases in theoretical animals, the third-year vet student at last gets to lay hands directly on actual animals.

Two weeks ago, I performed my first surgery, a castration of a dog. Of course, I made mistakes. But I started with a living animal and I ended with a living animal, so that counts as a success. It was all those details in between that got me. A surgery like this can take a regular general practioner about 10 minutes, far less time to complete than it takes to prep the dog for the surgery. For us, it can take over an hour.

I was as prepared as I could be. I watched videos. I wrote out, by hand, all of the steps. I read the instructor's notes on the OSU protocol. I practiced and practiced my suture patterns and knots. And even with all that, I made mistakes. But I also learned how to correct those mistakes, and I am fairly confident that, while I may make entirely new mistakes in the future, I won't make those particular ones again. Learning the hard way can certainly push the lesson firmly into your brain.

I had a deer-in-the-headlights moment during the surgery, and oddly, it wasn't when I was making the first incision. It occurred a few minutes later when I was holding the dog's right testis in one hand and gauze that I had used to strip the fascia off the spermatic cord in the other hand. I froze up, and only later did I realize explicitly what my lizard brain had already figured out: everything had been reversible up to that point. And at that point, there was no way to go but forward, to finish the surgery. I took several deep breaths then did just that.

I was terrified going into that surgery. The hubris of the idea that we would be cutting into a living animal and that the outcome was expected to be, was intended to be, better than the starting conditions, was an overwhelming burden. But that drove me to maximize the learning during every second of that long, long hour.

Later that week, we learned how to conduct a breeding soundness exam on a bull and I got to do my first rectal palpation. Kids raised on a farm will think, pfft, that's nothing, I've had my arm up the rectum of hundreds of cows. Yes, but there is always that first one.

Last week, we had our first dystocia lab. Dystocia describes a situation in which the cow can't give birth to the calf in a normal fashion. It can be caused by calves that are too big, calves that are dead, calves that are malpositioned, and so forth. Using a modeling device, essentially a large, zippered plastic bag that is attached to a metal ring on one end with the other end resting on a slanted metal plate, we took turns positioning a lubed-up dead calf in the bag then had our teammates attempt to describe the position of the calf via "vaginal palpation" (sticking their arm covered with an obstetrical glove through the metal hole and feeling the arrangement of the head and limbs of the calf). Then we got to reposition the calf and pull it out, learning how to properly attach chains to its feet and head.

If you think any of this is shocking, I can assure you that I am sparing you even crazier details.

But I will make these comments. The dogs that the students operated on are shelter dogs. They can't go to new homes until they are neutered. We are providing a useful service to the community. And we are watched like hawks. There are fourth-year students, residents, lab techs, and instructors swarming around each operating table. The bull was from the university beef farm. He was probably more annoyed at being stuck in the squeeze chute for an hour than he was by the exam and palpations. The calves were born dead, brought in by clients or collected from the OSU farms or large-animal hospital, and kept frozen until the lab. Yes, there is a risk in having an inexperienced student cut into a living animal or stick their arm into the rectum of a perfectly healthy bull. But those risks are mitigated by engaged instructors who make sure we are ready, classmates who will catch us if we stumble, and having a little bit of healthy fear for the process.

Sunday, September 24, 2017

Diary of a Third-Year Vet Student: I, Surgeon

I know, it's been over a month since I posted anything. It's not like there has been nothing going on at CircusK9, but I haven't felt that the goings-on were all that blog-worthy. I gave my laying hen/ovarian cancer talk (well received, lots of positive faculty questions and feedback), I testified in a sexual discrimination/tenure revocation case for the university (I may post on this later but I'll just leave it like this for now), and classes started back up last week. Archie got his second Excellent Jumpers Q yesterday with a very fine run (I am determined to keep up his classes and competition). And I perform my first surgery on Monday afternoon, an elective neuter on a shelter dog. Since this is a post in the recurring series "Diary of a Vet Student", let's unpack that one a bit more.

After we took our Principles of Surgery lab final exam at the end of the spring term, one of the things we had to do was record our height on a spreadsheet. The student teaching lab manager used that information and her own personal observations of us during the spring term to divide us into groups of three. The team of three will rotate through three positions: surgeon, assistant, and anesthesiologist. Each of us will take each role for a dog neuter, a cat neuter, and a dog or cat spay. But why height? The surgery tables are adjustable, and are set to fit the needs of the surgeon. But if the surgeon's assistant or the anesthesiologist are much taller or shorter than that surgeon, they might have difficulty doing their jobs for that particular surgery. So, for a very reasonable reason, our lab partners this term are similar to us in height.  

Here's where things get interesting. From my team of three, I was chosen to be the surgeon for the first surgery of the term. Monday. Tomorrow. I assumed that was random, since we all get to do it eventually. But I found out today that it might not have been random at all. I trust my source for this intel but I'm not sure the person she got it from wasn't maybe pulling her leg. My friend told me that those of us picked to be surgeons for the first surgery were chosen because we were deemed to be the most level-headed of our team, the ones who, it was thought, would hold up better under the stress that this first surgery is going to put on us all. Experience didn't factor in. I sort of want this to be true, since I've never cut into a live animal before (that is, I have no direct surgical experience) and one of my teammates has. But when I look at them, smart and clever and not at all flappable, I wonder, am I really more level-headed than they are?

For some weeks now, I've been practicing suture patterns and knots until my hands get sore, watching videos, reading the recommended texts. I think I am ready. It won't be perfect but I trust my teammates to catch me if I fall. Exactly as I would do for them. 

Got to cut this one short. I need to watch the video about how to make buried knots again before I go to bed.

Monday, August 21, 2017

Apoc-Eclipse at CircusK9: The Happening

Because Corvallis was in the path of totality, I was able to sit comfortably in my driveway and watch the entire thing. I built a camera obscura, or pinhole camera, and took some photos of the event. Well, I took 117 photos, to be precise, but quickly deleted about one-fourth of those upon first review--out of focus, weird angle, didn't get the entire pinhole pattern in the image. Since I knew exactly, to the second, when it would begin, I spent about 20 minutes fooling around with the pinhole camera, experimenting with my imaging setup: how far to hold the pinholes from my viewing paper, what was the best angle for the pinholes so sunlight would hit the holes as perpendicularly as possible, where to hold the digital camera, how close to the viewing paper the camera needed to be to get a clean image. Here is my setup:


Yep: a piece of white paper taped to a flattened cardboard box propped up against a chair, a piece of cardboard from some junk mail with a hole covered with a piece of foil, and two rulers taped on to hold it nice and straight. That's some high-tech shit right there. In a nod to whimsy, I decided to poke a pattern of holes into the foil, not just one.

It was a neat event and I'm glad I got to observe it.



This one is my favorite. I only cropped it down a bit, no other edits.



Stupid plane flew by just before totality, leaving a con-trail in the sky. You can see my shitty little camera trying hard to find that dark spot of the moon in the center.

Thursday, August 17, 2017

Laying Hens and Epithelial Ovarian Cancer



Re Apoc-eclipse, stores around here are running out of bottled water and plastic gas cans, and gas stations in rural eastern Oregon are running low on gasoline. The internet is starting to bog down too (they are also predicting possible cell service outages on Monday due to the increase in users). Just look at this google map of traffic trying to get out of Portland. Sheesh, it's only 3:30pm on Thursday.


But that's not what I wanted to rant about. I wanted to post about my research project. I've been working on this project for three years now. I've cobbled together funding from several sources, and the entire thing has been run on a shoestring budget. This is my last free summer while in vet school, and I have to get everything wrapped up by the end of September, or at least as wrapped up as research ever gets. Which is really never if your project is exciting and you enjoy doing serendipitous discovery-driven science. 

For three years, I've been using laying hens to study ovarian cancer. Yeah, I know, that's pretty weird. Laying hens are not exactly the kind of laboratory animal you think of first. But they spontaneously develop tumors in the surface epithelium of their ovaries, and these tumors are microscopically and chemically similar to those that develop in women. Risk of this cancer in hens increases with age, just as it does in women. And the disease progression is very similar, such that advanced disease stages in hens are accompanied by metastases to other peritoneal organs and ascites, or fluid in the peritoneal cavity.

Why do hens get this type of cancer? Two easy reasons jump out: we have genetically selected commercial strains of hens to lay about an egg a day, which means an ovulation every 24 hours or so, and we manipulate the photoperiod of their environment to keep them in a continually active reproductive state. So after 24 months or so of this, they begin to get epithelial ovarian cancer. 

The big problem with this disease in women is that symptoms are non-specific and it is usually diagnosed late. The five-year survival rate of this disease following diagnosis, irrespective of treatment, is sadly low. Early detection is an elusive goal. But it is hard to get data on early expression of this disease in women. We can't just go around and sample ovaries of 20-year-old women to see what's going on. What are we looking for anyway?

When I learned that hens are a robust model for this disease, I thought, well, I know a little bit about chickens and maybe I can contribute something of value to this problem. Yeah, I know, it sounds crazy. Cancer research is big business with big-name players. Who the hell am I to get involved in that.

Well, I'll tell you. I am a scientist. I always have been. I am driven to learn about the world around me by my curiosity. I am not afraid to tackle new things because I know how to learn. The road to hell is paved with good intentions but I decided to head on down there with my ideas anyway.

Last summer, when I was looking at microscope slide after slide of hen ovaries, I realized that there was no detailed description of what a normal laying hen ovary looked like. Plenty of papers described gnarly cancerous ovaries. But where were the references for normal? What was the range of normal? I went to my collaborators and they all said, yeah, looks like you'll have to write that yourself. So I did. I hope to have a manuscript on the "histopathology of the normal laying hen ovary" submitted to an online journal in a couple of weeks. Submitted doesn't mean accepted but it's a necessary first step. I'm first author with three established names behind mine. It is a good paper and I will be extremely proud to see that one published (eventually....).

With that out of the way, I returned to my original plan: what does early expression of ovarian cancer look like in hens? Were there any proteins that I could measure in the blood of the hens that I could associate with disease before it forms grossly visible tumors? If so, was that protein also measurable in women?

While describing all those normal ovaries, I began to notice a few ovaries that seemed a bit abnormal. With more careful looking, my collaborators and I decided that we did in fact have a pathology in those ovaries that had not been described before. The pathology is associated with an increase in a specific type of immune cell, the heterophil, and an absence of small follicles. Heterophils in birds act like neutrophils in mammals: they are first responders to the site of tissue injury or a microbacterial invasions. They are usually associated with acute inflammation, and are mostly gone after about 24 hours when other immune cells take over. But there was no evidence that the heterophils in the abnormal ovaries were acting like that. So what the heck were they doing? 

I dived back into the cancer research literature, this time reading up on cancer and inflammation. A rich topic indeed. And I discovered that epithelial ovarian cancer in particular is associated with an increase in a key inflammatory protein that has also been associated with avian heterophils. So I ran a fancy test on the hen serum then statistics on the results and found that the hens with abnormal ovaries had elevated levels of this particular protein in their serum. So for our second manuscript, I'm proposing a link between early neoplastic changes, an increase in this inflammatory protein (it is secreted by cancerous epithelial cells), and the increase in heterophils and absence of small follicles in the affected hen ovaries. It's a link that has not been made before. 

I may not ever return to this project, although much more work can be done with it. I've learned a lot about laying hen anatomy (gross and micro) and reproduction, and I've learned a lot about ovarian cancer. Oh, and that rabbit-hole I dived into to learn about inflammation was time well spent. It is exciting to find things that nobody else has stumbled across yet. It is affirming to make even these small contributions to our body of scientific knowledge.